Social Determinants of Health in Cardio-Oncology: Key Points

Baah FO, Sharda S, Davidow K, et al.
Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024;May 7:[Epublished].

The following are key points to remember from a state-of-the-art review on social determinants of health (SDoH) in cardio-oncology:

  1. Both childhood and adult cancer survivors are at a higher risk for early-onset cardiovascular diseases (CVDs), such as hypertension, heart failure, and arrhythmias, due to cancer therapies and adverse SDoH.
  2. Lower socioeconomic status (SES), characterized by poverty and lower educational attainment, correlates with higher rates of relapse and mortality in cancer patients, and contributes to increased risks of obesity, diabetes, and other CVD risk factors.
  3. Structural racism and limited health care access impede early detection and treatment of CVD in cancer patients, leading to delayed care and worse health outcomes among racial and ethnic minorities.
  4. Lower educational attainment impacts the ability to navigate the health care system, advocate for quality care, and engage in health-promoting behaviors, thereby worsening CVD outcomes in cancer patients from underrepresented groups.
  5. Living in disadvantaged neighborhoods with poor access to health care facilities and recreational spaces increases the risk of sedentary behavior, poor diet, and subsequent CVD in cancer survivors.
  6. Chronic psychological stress, adverse childhood experiences, and depression are linked to higher cardiovascular risks in cancer patients. Support systems and community cohesion can mitigate these risks.
  7. Lack of access to nutritious food disproportionately affects socioeconomically disadvantaged cancer patients, contributing to poor cardiovascular health and increased mortality.
  8. Chronic exposure to adverse SDoH activates biological pathways, such as the hypothalamic-pituitary-adrenal axis and inflammatory responses, contributing to CVD and cancer therapy-related toxicities.
  9. Geographic limitations, particularly in rural areas, and financial barriers to care hinder access to specialized cardio-oncology services, leading to suboptimal management of CVD in cancer patients.
  10. Active involvement of community stakeholders and continuous feedback are essential to tailor interventions that address the specific needs and barriers faced by diverse populations in cardio-oncology care.

Clinical Topics: Cardio-Oncology, Prevention

Keywords: Cardio-oncology, Social Determinants of Health

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